Female Genital Cutting

(also known as female circumcision, female genital mutilation, and female genital excision)

Female genital cutting refers to all procedures involving partial or total removal of female genitalia or other injury to female genital organs for any cultural, religious or otherwise nontherapeutic reasons. This practice is common in many refugee populations, particularly those from East Africa (i.e. Somalia, Ethiopia, Sudan), although the practice is pervasive throughout the world. This controversial practice is considered a human rights violation by many, and it is illegal in the United States in people under 18 years of age. The World Health Organization (WHO) has condemned the practice and is making efforts to end it. The practice poses adverse medical consequences, including direct complications from the procedure (anesthesia or sedation complications, bleeding, acute infection), increased risk of death for both mother and infant in subsequent pregnancies, post-traumatic stress disorder, and urinary tract infections, among others. In addition, there may be adverse consequences for the woman’s sexual well-being.

An external genital examination will reveal whether a girl or woman has undergone this procedure. Although this examination is required on the overseas medical evaluation, it may not have been performed, and the domestic medical screening evaluation presents an opportunity to identify women who have had the procedure. The exam may also provide opportunities to interrupt the practice in future generations. When the practice is identified, the clinician should record what type of procedure was performed (Table 5). Culturally sensitive counseling and educational materials should be offered and, when necessary, referrals provided (e.g., for complications or posttraumatic stress disorder). The refugee can be informed that the procedure is illegal in the United States.

More detailed information regarding female genital cutting is available from the World Health OrganizationExternal.

Table 5. World Health Organization Categorization of Female Genital Cutting

Type I Partial or total removal of the clitoris (clitorectomy).
Type II Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora.
Type III Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or majora (infibulation), with or without excision of the clitoris.
Type IV All other harmful procedures to the female genitalia for nonmedical purposes (e.g., piercing, incising, pricking, scraping, and cauterizating)